Recovery of right ventricular function after intermediate-risk pulmonary embolism: results from the multicentre Pulmonary Embolism International Trial (PEITHO)-2

Abstract

Background Right ventricular (RV) function plays a critical role in the pathophysiology and acute prognosis of pulmonary embolism (PE). We analyzed the temporal changes of RV function in the cohort of a prospective multicentre study investigating if an early switch to oral anticoagulation in patients with intermediate-risk PE is effective and safe. Methods Echocardiographic and laboratory examinations were performed at baseline (PE diagnosis), 6 days and 6 months. Echocardiographic parameters were classified into categories representing RV size, RV free wall/tricuspid annulus motion, RV pressure overload and right atrial (RA)/central venous pressure. Results RV dysfunction based on any abnormal echocardiographic parameter was present in 84% of patients at baseline. RV dilatation was the most frequently abnormal finding (40.6%), followed by increased RA/central venous pressure (34.6%), RV pressure overload (32.1%), and reduced RV free wall/tricuspid annulus motion (20.9%). As early as day 6, RV size remained normal or improved in 260 patients (64.7%), RV free wall/tricuspid annulus motion in 301 (74.9%), RV pressure overload in 297 (73.9%), and RA/central venous pressure in 254 (63.2%). At day 180, the frequencies slightly increased. The median NT-proBNP level decreased from 1448 pg/ml at baseline to 256.5 on day 6 and 127 on day 180. Conclusion In the majority of patients with acute intermediate-risk PE switched early to a direct oral anticoagulant, echocardiographic parameters of RV function normalised within 6 days and remained normal throughout the first 6 months. Almost one in four patients, however, continued to have evidence of RV dysfunction over the long term. Graphical Abstract

Risk factors and prediction model for chronic thromboembolic pulmonary hypertension in acute pulmonary embolism patients with right heart dysfunction on CT or echocardiography

“…ASL FS et al also showed that none of the patients with haemodynamic instability or reperfusion therapy were diagnosed with CTEPH during follow-up [17]. However, in patients with haemodynamically stable pulmonary embolism, there was no signi cant difference in treatment method between the groups (p > 0.05), which was consistent with the conclusions reached in previous studies [22] and may be related to less thrombolytic therapy in patients with stable haemodynamics. In the present study, the application of catheter-directed thrombolysis (CDT) in patients with intermediate-high risk pulmonary embolism was conducive to the recovery of right heart function and pulmonary artery pressure and to reducing CTEPH incidence [23,24].…”

Long-Term Outcomes Associated with a Pulmonary Embolism Response Team, a Retrospective Cohort Study

“…This signal for preservation of RV function is subject to bias by unmeasured confounders, but may have clinical signi cance given that persistent RV dysfunction predicts poorer long-term clinical outcomes for patietns with acute pulmonary embolism. 52 Propensity-matched analyses demonstrated greater adherence to guideline-recommended follow-up metrics including referral to and achievement of dedicated PE follow-up and consideration of anticoagulation. This increased surveillance may also account for the observed trend toward an increase in documented PE/VTE recurrence among PCs, who tended to undergo more imaging studies, and had greater contact with the healthcare system.…”